Medicaid and the Opioid Epidemic

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June 2017 | Substance Use Disorder

Chapter 2 describes the nationwide opioid epidemic and how state Medicaid programs are responding. The epidemic disproportionately affects Medicaid beneficiaries, who are prescribed pain relievers at higher rates than those with other sources of insurance and have a higher rate of opioid use disorder. The analysis finds that Medicaid beneficiaries receive inpatient and outpatient treatment at higher rates than people who are privately insured.

The chapter details state responses, including work to reduce overprescribing and misuse of opioids, coverage of medication-assisted treatment, and innovative use of Medicaid legal authorities to expand treatment and integrate physical health and substance use disorder delivery systems. Yet because many Medicaid addiction services are optional, states vary considerably in the services they cover and many Medicaid enrollees are still not receiving treatment. Only about 32 percent of Medicaid enrollees with an opioid use disorder were receiving treatment in 2015.

The chapter concludes by describing barriers to care. These include individuals not perceiving the need for treatment; a fragmented and poorly funded delivery system; privacy regulations that may limit care coordination; a shortage of providers trained in medication-assisted treatment; and gaps in the continuum of care associated with both restrictive coverage policies and the institution for mental diseases payment exclusion.

Publication Type: Reports to Congress

From: June 2017 Report to Congress on Medicaid and CHIP

Tags: behavioral health, benefits, institutions for mental diseases (IMD), prescription drugs, Section 1115 research and demonstration project waivers, substance use, substance use treatment